DR. JASON LOUIS ILTZ (NPI# 1528056108) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528056108 |
| Entity Type | Individual |
| Full Name | DR. JASON LOUIS ILTZ |
| Credential | B.PHARM., PHARM.D. |
| Practice Address |
12404 S. Carter Rd Valleyford WA 99036 |
| Mailing Address |
Po Box 404 Valleyford WA 99036-0404 |
| Practice Telephone | 5099791926 |
| Mailing Telephone | 5099791926 |
| Enumeration Date | 2005-10-08 |
| Last Update Date | 2010-03-26 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1835N1003X |
Pharmacist Specialization: Nutrition Support |
PH00019404 | WA | Pharmacy Service Providers |
| N | 1835P1200X |
Pharmacist Specialization: Pharmacotherapy |
PH00019404 | WA | Pharmacy Service Providers |
| N | 261QI0500X |
Clinic/Center Specialization: Infusion Therapy |
PH00019404 | WA | Ambulatory Health Care Facilities |
| N | 261QP3300X |
Clinic/Center Specialization: Pain |
PH00019404 | WA | Ambulatory Health Care Facilities |
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
PH00019404 | WA | Pharmacy Service Providers |
| Street Address |
12404 S. CARTER RD |
| City | VALLEYFORD |
| State | WA |
| Zip Code | 99036 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184741621 | Leslie Spring | Massage Therapist | 12310 E. Connor, Valleyford, WA 99036 | 2007-03-22 |
| 1629258165 | Kristina Luella Rice Erso | Psychologist | 15110 S Valley Chapel Rd, Valleyford, WA 99036-9768 | 2007-11-13 |
| 1477744415 | Mary Christine D'auria | Specialist | 12702 E Connor Rd, Valleyford, WA 99036-9792 | 2007-08-06 |
| 1932519626 | Mary D'auria | Massage Therapist | 12702 E Connor Rd, Valleyford, WA 99036-9792 | 2014-05-02 |
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891395760 | Evelyn Tong | Pharmacist | 4229 122nd Ave Se, Bellevue, WA 98006-1915 | 2020-10-29 |
| 1356985345 | Nancy Celine Tran | Pharmacist | 906 S 38th Ct, Renton, WA 98055-5897 | 2019-11-01 |
| 1265087654 | Valorie Swensen | Pharmacist | 4500 Harrison St, Bellingham, WA 98229-3323 | 2019-08-02 |
| 1982110805 | Derek Matlock | Pharmacist | 3715 Ocean Beach Hwy # 2, Longview, WA 98632-4801 | 2017-12-15 |
| 1659880938 | Hazel Ann Feist | Pharmacist | 14406 Nw 20th Ave, Vancouver, WA 98685-8007 | 2017-09-29 |
| 1528586732 | Mayumi Robbins | Pharmacist | 410 9th Ave N Fl 7, Seattle, WA 98109-4708 | 2017-09-07 |
| 1699293688 | Jin Man Choe | Pharmacist | 105 W 8th Ave Ste 350, Spokane, WA 99204-2312 | 2017-08-30 |
| 1821457813 | Marie Cermak | Pharmacist | 12333 Ne 130th Ln # Lane415, Kirkland, WA 98034-7467 | 2016-02-18 |
| 1902281959 | Carmen Joy Berg | Pharmacist | 2320 South Salnave Road, Medical Lake, WA 99022 | 2015-07-20 |
| 1639574981 | Loi Chau | Pharmacist | 601 Broadway Rm 117, Seattle, WA 98122-5330 | 2014-10-29 |
| Find all providers with the same taxonomy | ||||
| City | VALLEYFORD |
| Zip Code | 99036 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.